have courage. take heart. bear witness.

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David Houppert and Tom Berger interview transcript

Hazardous to your health

David: People now know what PTSD stands for. And I think six, seven years ago, some people would know, but a lot of people wouldn't. And part of that is due to the educational outreach, or lack thereof, by the VA [US Department of Veterans Affairs]. And, for example, I'm a licensed attorney. I had a background in health care law before coming to VVA [Vietnam Veterans of America] as an appellate attorney—before I became the director of Veterans Benefits. And I worked here at VVA for a couple of months, as an attorney, before I even knew there were benefits for Gulf War veterans.

There are presumptions for Gulf War veterans, meaning if you served in the Persian Gulf anytime after August 4th or 6th of 1990 to the current date, if you come down with any of a number of undiagnosed disabilities, or a number of diagnosed disabilities, you're entitled to benefits from the VA, which can include health care, monthly compensation, etc. I didn't know that. Nobody ever told me that. And maybe I should have read it somewhere, but if someone doesn't tell me, and I'm not looking for it, I had no clue.

And it just worries me, because how many other people are there out there who simply don't know about these things, and no one is telling them? It's gotten, by far, better than it was, but it's still not where it should or where it could be. And in my work, on a daily basis, I talk to so many people from Tom's era, who are just now realizing that they're eligible for benefits.

And one thing we haven't talked about yet is Agent Orange and its effect from the Vietnam war. If you served in in-country—in Viet Nam—it's presumed that you came into contact with Agent Orange. Agent Orange has some nasty little ingredients in it, which lead to a number of diseases. And if you come down with these diseases, either within a certain amount of time after leaving Viet Nam or any time in your life again, you're eligible for health care and compensation. And two of the big ones we see are prostate cancer, diabetes type 2. And it's actually been recognized by the government that Agent Orange is so bad, some offspring of veterans are eligible for birth defects.

We did an Agent Orange Awareness tent on the [Washington] Mall in 2007 for Veterans Day. And I had a young woman come in, who was probably in her late twenties. And she was talking to me, and in the course of the conversation, she mentioned she had spina bifida. She also mentioned her younger sister had spina bifida. We talked further, and her father, who was a Vietnam in-country veteran had diabetes type 2 and prostate cancer.

Neither the children nor the father knew they were entitled to benefits from the VA. The children could have been receiving a monthly allowance, health care, voc [vocational] rehab and education benefits. The father would have been entitled to monthly compensation, health care. And he had had prostate cancer, I think, for five or six years, and diabetes type 2 for twelve years, which he had been paying for out-of-pocket or with his private insurance. Even if you have good private insurance, you still have copays and everything else. But again, no one ever told him that because of his military experience, he might be entitled to benefits.

Tom: The bulk of the veterans community out there doesn't know that military service can be hazardous to your health. Even worse, though, is the bulk of the American people and the medical community do not know that military service can be hazardous to your health.

In addition, mental health problems are not the same as physical health problems. And what I'm saying here is that someone who's got mental health problems, or faces mental health challenges as a result of their military service, isn't the same . . . it's not the same kind of wound as a broken arm is. In other words, you get a broken arm, you go in, you get it set. Maybe you have to do some physical therapy afterwards, and you're never going to pitch for the Yankees again, but it doesn't work the same way with your mind.

Mental health treatment and programs are expensive and they're long term. You just don't fix them overnight. There's nothing wrong with being in long-term mental health. People who have diabetes have to take medication for the rest of their life. There's nothing wrong with that if you get it under control—do all the other things you're supposed to do.

And that's the same way that we need to begin to look at mental health issues—is that they're just chronic, or can be chronic, long-term diseases. And as long as you do your treatments, take your meds, and what have you, there is no problem. But there's this negative stigma associated with mental health stuff that says, "Well, let's just lock 'em up."

So, if there's anybody out there listening, and they do have PTSD, or recognizes the symptoms, I urge you, strongly, to seek help. It's not a sign of weakness to seek help. You are a normal person. You were exposed to abnormal circumstances. So go get help, so you don't end up like so many Vietnam veterans did. And, certainly, don't do what we did and rely on drugs and alcohol to self-medicate, because that doesn't work. I can tell you from personal experience it doesn't work.

The three VAs

David: The VA [US Department of Veterans Affairs] is the largest health care provider in the US. And the number of physicians that, at one time or another is involved with the VA, is phenomenally high. I forget the percentage, but there's an extremely large number of teaching hospitals, for example, that are . . . have their agreements with the teaching colleges, universities, etc, who do work for or with the VA.

And a lot of these physicians, during their training, come into contact with the VA system and veterans. And the VA's broken down into three separate groups, which is primarily the Veterans Benefits Administration, Veterans Health Care Administration, and Memorials and . . .

Tom: Cemeteries?

David: . . . Cemeteries. And you would think it would be one VA, but it's not at all uncommon for an individual to seek care and treatment at the VA for two or three, four years, but no one on the VHA side of the house tells the veteran they may be eligible for benefits. And in a lot of situations, the VHA physicians don't know. They're not trained on that. They don't understand the system, and they don't always realize that they could refer the veteran to file a claim and receive their compensation.

Tom: You know, for years, VVA has been pressing the VA to mandate the use of what we call military history. That is, as part of one's VA medical records, there should be a block on that record that says where you served, when you served, what your MOS [military occupational specialty] was. The VA even prints these small, four-by-four cards that are supposed to be used by the physicians to ask such questions.

Most of the time, the questions are not asked, and, furthermore, it doesn't appear on your medical record. so those are problems that need to be addressed by the VA, but also need to be addressed by the non-VA clinicians who are out there—doctors, nurses, what have you—out there. They need to be asking these questions of the clients that come in to see them.

I know, for example, that there are folks that go to see a physician, that they don't tell them that they served in Viet Nam or Iran or Iraq or any of the other places. But the physician should be asking those questions. That would make things run much more smoothly, in my opinion—if they would just ask some of those basic questions.

David: There's a misconception that veterans are cared for. I've always thought—and, actually, I still think—that if the general public fully understood and realized this, they would be truly outraged. But I think, among the general nonveteran population, they think they just simply have to walk into the VA building, their medical care is taken care of, they get their compensation. But they don't fully understand the current problem facing veterans.

Tom: That's exactly correct. And I think that stems from the larger problem, and that is—I mean, the current war is a good example—veterans health care has never really been considered as part of the national defense budget. In other words, if you're going to send our young people to resolve conflict, etc, in other words, use them as a tool of international politics—then, help their health care. It needs to be part of that.

David: Think of it this way—and I'm not making a political statement about the war in any way, shape, or form—but if you have a nineteen-year-old who's currently serving, whether it's Army, Navy, Air Force, Marines, Coast Guard—whatever the case may be—if that nineteen-year-old gets injured tomorrow, they live to be ninety-nine years old with that injury, the taxpayers are going to be paying for their compensation benefits for eighty years. After the war's over. Eighty years. And that's, again, it's got to be factored into the equation.

Tom: Exactly.

Traumatic brain injury (TBI)

Tom: One of the new things we've come across regarding mental health challenges in the new wars is this phenomenon—it's called TBI, traumatic brain injury. It's been labeled the signature wound of the war, although there's some evidence to indicate that hearing injuries are just as common. And, in some cases, we're hearing more about eye injuries now, because the physics of concussive explosions or concussive devices is such that it does lots of different things, because, essentially, your brain is just like Jell-O inside this thin, candy wrapping. In any case, there's all kinds of pressure things that go on. You're going to be hearing a lot more about claims for hearing kinds of things, later on.

Any case, let's go back to TBI for a minute. There are so many things that happen with traumatic brain injury—again, the result of, mostly in this conflict or these conflicts—concussive IEDs [improvised explosive devices] going off. I have actually heard representatives of DoD [Department of Defense] compare TBI received by our soldiers to that " that linebackers or defensive backs or wide receivers receive in the NFL [National Football League]. They're entirely different. I mean, one is an impact situation—the sports injury. It's not analogous, at all, to that kind of injury suffered as a result of an explosive device.

In any case, one of our concerns is our concern particularly about mild and moderate TBI. And there was just a paper released last week, that clearly shows long-term effects of moderate and mild TBI can lead to seizure disorder. And our concern is that the standard treatment for seizure disorder is drugs. But as soon as you start giving people drugs, you can also change their behaviors.

So let's take the example of a thirty-five-year-old combat veteran—comes home, mild or moderate TBI—several years down the road, begins suffering seizure disorder. They give him or her some drugs, changes the behavior, becomes frustrating. Maybe they're losing the ability to speak. Becomes more frustrating, and they lock 'em up. Now that a very drastic scenario, I understand. But that's typically what " the way that things go.

I mentioned mental health challenges being the most costly. Actually, TBI is the most costly, long-term kind of injury that can be suffered, whether it be in the civilian world or in the military world. There are very, very few places in this country—one happens to be located, believe it or not, out in Iowa—whose specialty is traumatic brain injury.

It takes a team of people to work with folks who have severe brain injury. And if we shift over to the kinds of help that's needed, we're talking about social services, social workers. While there are lots of social workers out there that can deal with psychological problems, there aren't very many clinical social workers who specialize in brain injuries, traumatic brain injuries, in particular.

So the American public should have some concern about this later on. What are we going to be doing with these veterans twenty years down the line? And that's, you know, something that everybody should be thinking about.